Healthcare Provider Details

I. General information

NPI: 1942019328
Provider Name (Legal Business Name): JERRYLIN TOSTE DIAZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 8
CAROLINA PR
00986-0008
US

IV. Provider business mailing address

URB CIUDAD JARDIN CALLE WEST ROSE 356
CAROLINA PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 787-626-3322
  • Fax:
Mailing address:
  • Phone: 787-460-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5435
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: